Medication Usage Research Articles

Single-Nuclei RNA-Sequencing Uncovers Alterations in the Transcriptional Profile of Skeletal Muscle in Peripheral Artery Disease

BACKGROUND: Lower extremity peripheral artery disease (PAD) is caused by atherosclerotic occlusion of lower limb blood vessels, impacting >200 million people worldwide. PAD causes life-altering symptomatology such as claudication, ischemic rest pain, and gangrene, with limited effective treatment options. Herein, we performed single-nuclei RNA-sequencing (snRNAseq) to facilitate a better understanding of the complex pathobiological environment within the PAD limb and intercellular communication. METHODS: Gastrocnemius muscle specimens were collected from 20 patients with PAD and 12 non-PAD controls. Patients with PAD were classified as Rutherford category 3 (severe claudication). Non-PAD participants were of similar age, body mass index and medication usage as patients with PAD. Nuclei were isolated and snRNAseq was performed. Bioinformatic analysis was conducted to determine differences in gene expression between PAD and non-PAD nuclei, as well as analysis of intercellular signaling networks. Histological analysis of muscle specimens assessed the following: myosin heavy chain fiber distributions, myofiber cross-sectional area and myofiber denervation. RESULTS: 57,364 high-quality nuclei were captured (21,417 PAD; 35,947 non-PAD) and unsupervised clustering revealed 12 distinct nuclei populations based on their transcriptional profile. Quantification of the relative abundance of nuclei populations identified several differences, including PAD muscles having a lower percentage of type I myonuclei, muscle stem cells, and endothelial cells but a higher proportion of type II and regenerating myonuclei. Differentially expressed gene analysis of myonuclei populations uncovered upregulation of genes involved in stress response, autophagy, and atrophy in patients with PAD. Ligand-receptor interactions were used to determine how PAD alters the communication between identified nuclei populations. The inferred strength of interactions was greater in non-PAD compared to PAD patients. Further, intercellular communication network analysis revealed fibro-adipogenic progenitors as a primary signaling hub in PAD muscle. CONCLUSION: snRNAseq uncovered novel transcriptional differences and intercellular communication pathways unique to PAD muscle. This study was supported by National Institutes of Health (NIH) grant R01-HL149704 (T. Ryan). K. Kim supported by the American Heart Association grant POST903198. T. Thome supported by NIH grant F31-DK128920. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Exploring Patterns of Medication Usage in Affective Disorder Patients: A Comprehensive Investigation at a Psychiatry Outpatient Clinic of a Tertiary Care Hospital.

Affective disorders impose a significant burden on public health due to their high prevalence and associated suffering. This study addresses gaps in current literature and clinical practice by providing insights into medication usage trends, which can inform treatment strategies and optimize patient care. The study aims to investigate drug utilization patterns, particularly focusing on defined daily dose/1000/day, among individuals attending a psychiatric outpatient department of a tertiary care hospital. This cross-sectional, prospective drug utilization study included 600 affective disorder patients aged 18 years and above. The study period spanned 12 months, from March 2021 to February 2022. Data on demographics, diagnosis, treatment, and counseling were collected and analyzed using descriptive statistics. Among the 600 patients analyzed, bipolar mood disorder was the most prevalent (239 patients, 39.83%), followed by depressive disorder (208 patients, 34.67%). Triple therapy was the most common prescription regimen, accounting for 308 encounters (51.33%). The average number of drugs per encounter was 3.75 ± 1.01. A combination of psychotherapy and medication counseling sessions was provided to 594 patients or their relatives, representing 99% of the total encounters. The study highlights the prevalent use of triple therapy in managing affective disorders, especially bipolar mood disorder and mania disorder. Effective utilization of essential drug lists and comprehensive patient counseling underscores the importance of holistic care in psychiatric outpatient settings. Given the high prevalence of triple therapy, further research into the efficacy and safety of this treatment approach is warranted. Additionally, continued emphasis on patient education and counseling can enhance treatment adherence and overall outcomes in individuals with affective disorders.

THE INVESTIGATION OF TRANSFERABILITY OF DEFINITIONS OF CARDIOMETABOLIC AND VASCULAR AGING PHENOTYPES ACROSS MULTIPLE COHORTS

Objective: According to the European guidelines for the prevention of cardiovascular diseases (CVD) (2021), Russia was identified as a country with a very high CV risk. We aimed to investigate the applicability of the standardized definitions of vascular aging phenotypes (VP) in Russian population and align them with the existing reference datasets. Design and method: In 2012-2013 1,600 residents of St. Petersburg (age 21-67) were randomly examined as a part of the multicenter epidemiological study. Anthropometry, blood pressure measurement, blood biochemistry analysis were taken. Subjects completed questionnaires describing their lifestyle, current health condition and medication usage. 618 patients (42% men) from initial cohort with a mean age of 48 [37;55] years were randomly subsampled for carotid-femoral pulse wave velocity assessment (Sphygmocor). The VP were defined using the ‘Reference Values for Arterial Stiffness’ Collaboration database which included 16,867 measurements from eight European countries populations15 to 97 years. According to the criteria, patients with overt CVD, diabetes mellitus and the use of antihypertensive, lipid-lowering therapy were excluded from the analysis of VP. Results: The Russian cohort had significantly higher prevalence of CVD (11,4% compared to 6,9% in the Nreference population, p=5.65x10-5), intake of antihypertensives (28,1% compared to 14,3% in the reference, p<1x10-16) and lipid-lowering therapy (6,1% compared to 4,1%, p=0.025, Figure 1A). Additionally, our cohort had significantly higher prevalence of optimal BP (40,2% vs 28%, p=4.6x10-7) and lower prevalence of first-degree (p=0.048) and second degree (p=0.00084) hypertension (Figure 1B). Comparison of the prevalence of VP between the European and Russian cohorts showed a significant decrease of the early vascular aging (EVA) phenotype with age in the Russian population (p=0.011). The prevalence of the supernormal vascular aging phenotype (SUPERNOVA) in the group of 60-69 years old was higher in the Russian population (p=0.0035) Conclusions: A higher prevalence of CVD was demonstrated in the study cohort despite lower hypertension burden and higher CV drugs intake compared to the European cohort. Multidirectional trajectories of EVA and SUPERNOVA VP with age were detected in Russian population, potentially indicating the presence of the clearing selection pressure at the older age (Agreement No 075-15-2022-301).

Study on the Impact of Exercise Prescription on Medical Insurance Cost Control

This study examines the role of exercise prescriptions in controlling medical insurance costs amidst the increasing prevalence of chronic diseases and rising healthcare expenses. Exercise prescriptions are customized physical activity plans issued by healthcare professionals that aim to improve health outcomes and reduce the financial burden on healthcare systems. Using a mixed-methods approach, this research combines quantitative data from electronic health records (EHRs) with qualitative insights from interviews and focus groups involving healthcare providers, patients, and insurance professionals. The quantitative analysis shows significant health improvements among patients with exercise prescriptions, including a 20% reduction in hospitalization rates and a 15% decrease in medication usage. The cost-benefit analysis suggests that the annual cost of implementing an exercise prescription program is approximately $150,000, whereas the resulting healthcare savings amount to $250,000, leading to a net saving of $100,000. Participants in these programs also see a 12% reduction in insurance premiums due to decreased healthcare utilization and improved health outcomes. Qualitative insights highlight better patient engagement, stronger provider-patient relationships, and perceived benefits like enhanced physical fitness and more effective chronic disease management. However, challenges such as limited resources and insufficient coverage for exercise prescription services are noted. Case studies from the United Kingdom and the United States affirm the cost-effectiveness of exercise prescriptions, displaying significant health benefits and financial savings. The study concludes that exercise prescriptions are a cost-effective strategy for managing chronic diseases and reducing healthcare costs. It recommends integrating exercise prescriptions into routine clinical practice and supporting their adoption through strategic policies and incentives, paving the way for substantial health and economic gains for healthcare systems. Further research should investigate the long-term effects and ways to improve patient adherence to exercise prescriptions.

Impact of COVID-19 on Dental Surgeons in Kerala: A Cross-sectional Online Survey

Abstract Background: This cross-sectional study among dentists in Kerala assessed the COVID-19 prevalence and severity, vaccination status, and medication usage in August 2022. Materials and Methods: A questionnaire was created to assess the impact of COVID-19 on dental surgeons in Kerala. This questionnaire had 19 questions with multiple choices which were converted into Google Forms and distributed among the dentists residing in Kerala. Results: A total of 650 dentists responded to the questionnaire, yielding a response rate of 76.4%. As of August 2022, the prevalence of COVID-19 among Kerala dentists was found to be 33.23%. 60.7% of positive dentists were either asymptomatic or had only mild symptoms. 99% had received at least one vaccine dose, mainly Covishield. The prevalence of COVID-19 positivity was higher among dentists with postgraduate degrees (47.4%) in comparison with participants holding only BDS degrees. Conclusion: The prevalence of COVID-19 among practicing dentists was 33.23%. All dentists were vaccinated and used good preventive measures.

Building Medication Profiles in the Elderly: a Qualitative Study Based on Medication Information Literacy in a Long-Term Care Facility.

Long-term care facilities are increasingly challenged with meeting the diverse healthcare needs of the elderly population, particularly concerning medication management. Understanding medication information literacy and behavior among this demographic is imperative. Therefore, this qualitative study aims to explore medication information literacy and develop distinct medication profiles among elderly long-term care residents. In this study, we conducted in-depth semi-structured interviews with 32 participants aged 65 or older residing in a long-term care facility. The interviews were designed to explore participants' understanding of medication information, medication management practices, and experiences with healthcare providers. Thematic analysis was employed to analyze the interview data, allowing for the identification of common patterns and themes related to medication-taking behavior among the elderly residents. The thematic analysis revealed four distinct medication behavior profiles among the elderly long-term care residents: (1) Proactive Health Self-Managers, (2) Medication Information Adherents, (3) Experience-Based Medication Users, and (4) Nonadherent Medication Users. These findings provide valuable insights into the diverse approaches to medication management within long-term care facilities and underscore the importance of tailored interventions to support the specific needs of each profile. This study highlights the necessity for tailored medication education and support to optimize medication management for the elderly. With the aging population expansion, addressing the unique medication challenges within long-term care facilities becomes increasingly critical. This research contributes to ongoing endeavors to enhance healthcare services for the elderly, striving for safer and more effective medication-taking behavior.

Measuring the Influence of Side Effect Expectations, Beliefs, and Incident Side Effects on the Risk for Drug Discontinuation Among Individuals Starting New Medications, a Cross-sectional Study.

To measure the impact of beliefs, expectations, side effects, and their combined effects on the risk for medication nonpersistence. Using a cross-sectional design, individuals from Saskatchewan, Canada who started a new antihypertensive, cholesterol-lowering, or antihyperglycemic medication were surveyed about risk factors for nonpersistence including: (a) beliefs measured by a composite score of three questions asking about the threat of the condition, importance of the drug, and harm of the drug; (b) incident side effects attributed to treatment; and (c) expectations for side effects before starting treatment. Descriptive statistics and logistic regression models were used to quantify the influence of these risk factors on the outcome of nonpersistence. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Among 3,029 respondents, 5.8% (n=177) reported nonpersistence within four months after starting the new drug. After adjustment for numerous covariates representing sociodemographics, health-care providers, medication experiences and beliefs, both negative beliefs (OR: 7.26, 95%CI: 4.98-10.59) and incident side effects (OR: 8.00, 95%CI: 5.49-11.68) were associated with the highest odds of nonpersistence with no evidence of interaction. In contrast, expectations for side effects before starting treatment exhibited an important interaction with incident side effects following treatment initiation. Among respondents with incident side effects (n=741, 24.5%), the risk for early nonpersistence was 11.5% if they indicated an expectation for side effects before starting the medication compared to 23.6% if they did not (adjusted OR: 0.38, 95%CI: 0.25-0.60). Expectations for side effects may be a previously unrecognized but important marker of the probability to persist with treatment. A high percentage of new medication users appeared unprepared for the possibility of side effects from their new medication making them less resilient if side effects occur.

Umbilical Cord Blood Collection During Cesarean Section: Effect on Maternal Blood Loss and Morbidity [ID 2683610

INTRODUCTION: Umbilical cord blood collection (UCBC) for stem-cell banking is routinely performed during cesarean sections (CS). Few studies have examined the maternal effect. This study's objective is to evaluate whether UCBC during CS is associated with increased maternal blood loss and morbidity. METHODS: This was a single-center retrospective cohort study of primary CS (PCS) in 2021. Exclusion criteria were age less than 18, multifetal gestation, gestational age less than 34 weeks, emergency, and infection. Data were compared between participants with and without UCBC during PCS. Extensive demographic data was collected and compared. The primary outcome was quantitative blood loss (QBL). Secondary outcomes were operative time, hemorrhage medication usage, and blood transfusion (BT). RESULTS: Eight hundred two PCS were reviewed, and 191 were excluded. Of the remaining 611, UCBC was attempted in 151 (24.7%). The UCBC cohort had higher gestational age (39.1 versus 38.7; P=.007), were less often in labor (P=.004) or on magnesium (P=.022), and were more likely to be scheduled (P=.002). Quantitative blood loss was higher with UCBC (1,091.5 versus 1,007.5 mL; P=.075). In non-labored PCS, the QBL difference was statistically significant (941.8 versus 798 mL; P=.034). Umbilical cord blood collection was associated with increased operative time (62.4 versus 56.8 minutes; P<.001) and postoperative BT (7.2% versus 3.3%; P=.036). There were no associations between UCBC and usage of hemorrhage medications. CONCLUSION: Umbilical cord blood collection increases QBL in nonlabored PCS. Umbilical cord blood collection increases operative time and postoperative BT in PCS. Patients should be appropriately counseled and selected for UCBC based on hemorrhage risk factors.

Study protocol of a prospective, interventional non-randomised trial investigating the impact of asthma education on specific disease understanding, health literacy and therapy outcome in childhood

IntroductionChildhood asthma is a highly prevalent chronic disease. A failure to implement patient education programmes may result in increased morbidity, despite the availability of distinct diagnostic and therapeutic approaches. Patients...

BLOOD PRESSURE VARIABILITY AND HISTORY OF CARDIOVASCULAR EVENTS IN MAY MEASUREMENT MONTH 2019 PARTICIPANTS

Objective: Increased blood pressure variability (BPV) is associated with negative health outcomes, but its determinants, and how best to measure it, remain unclear. We aimed to explore differences in four commonly used measures of BPV by clinical factors in the May Measurement Month (MMM) 2019 global survey. Design and method: We performed an observational analysis of BP readings from MMM 2019 survey participants. Volunteer adult (18 years or older) participants were surveyed via convenience sampling from 92 countries in May 2019. Each participant had three seated BP readings. Four indices of diastolic and systolic BPV were calculated for participants with all three BP readings: the standard deviation (SD), coefficient of variation (CV), absolute difference between the second and first BP readings (AR), and the variation independent of the mean (VIM). Factors examined included use of antihypertensive medication, being obese (body mass index greater than 29 kg/m2), and having a diagnosis of diabetes, myocardial infarction, or stroke. For each BPV index and factor, a regression model was created with the index as the outcome. Each model was adjusted for mean BP (based on the average of the second and third BP readings), age, sex, an interaction between age and sex, and antihypertensive medication use. Age and mean BP were each included as natural cubic splines with five knots. Results: Data from for 1,133,008 (75.1%) participants were included. The mean age was 45.6 (SD 16.6) and 52.0% were female. Coefficient estimates were similar for SD, VIM, and CV (Figure 1). Lower systolic and diastolic BPV were seen in participants who reported use of antihypertensive medication, and in those with a previous history of stroke, diabetes, or MI. There were small but statistically significant differences by obesity status. Conclusions: Diabetes, a history of myocardial infarction or stroke and the use of antihypertensive medication were associated with lower within-visit BPV, independent of age or sex. This may reflect underlying physiological differences between groups or differences in BPV-lowering effects resulting from different lifestyle choices or medication usage of these participants.

Electronic Real-Time Monitoring Reveals Limited Adherence to Long-Term Opioid Prescriptions in Pain Patients.

Pain management physicians are increasingly focused on limiting prescription opioid abuse, yet existing tools for monitoring adherence have limited accuracy. Medication event monitoring system (MEMS) is an emerging technology for tracking medication usage in real-time but has not been tested in chronic pain patients on long-term opioid regimens. We conducted a pilot clinical trial to investigate the utility of MEMS for monitoring opioid adherence and compared to traditional methods including self-report diaries, urine drug screen (UDS), and physicians' opinions. Opioid-maintained chronic pain patients were recruited from a pain management clinic. Participants (n=28) were randomly assigned to either receive MEMS bottles containing their opioid medication for a 90-day period or to continue using standard medication bottles. MEMS bottles were configured to record and timestamp all bottle openings and the number of pills that were removed from the bottle (via measurement of weight change). Participants who received MEMS demonstrated highly heterogenous dosing patterns, with a substantial number of patients rapidly removing excessive amounts of medication and/or "stockpiling" medication. By comparison, physicians rated all participants as either "totally compliant" or "mostly compliant". UDS results did not reveal any illicit drug use, but 25% of participants (n=7) tested negative for their prescribed opioid metabolite. MEMS data did not correlate with physician-rated adherence (P=0.24) and UDS results (P=0.77). MEMS data consistently revealed greater non-adherence than self-report data (P<0.001). These results highlight the limits in our understanding of naturalistic patterns of daily opioid use in chronic pain patients as well as support the use of MEMS for detecting potential misuse as compared to routine adherence monitoring methods. Future research directions include the need to determine how MEMS could be used to improve patient outcomes, minimize harm, and aid in clinical decision-making. This study was preregistered on ClinicalTrials.gov (NCT03752411).

Long-Term Reductions in Opioid Medication Use After Spinal Stimulation: A Claims Analysis Among Commercially-Insured Population.

Chronic, non-cancer pain significantly and negatively impacts patient quality of life. Neuromodulation is a major component of multi-modal interdisciplinary approaches to chronic pain management, which includes opioid and nonopioid medications. In randomized controlled trials, spinal cord stimulation (SCS) has been shown to reduce pain and decrease short-term opioid use for patients. This study sought to evaluate the effect of SCS on longer term opioid and non-opioid pain medication usage among patients over ≥3 years of follow-up. Claims analysis was conducted using the Merative™ MarketScan® Commercial Database. Patients aged ≥18 who initiated SCS between 1/1/2010 and 3/31/2021 with ≥1 year of baseline data and ≥3 years of follow-up data were included. Opioid discontinuation, daily dose (DD) reduction, proportion of days covered (PDC), concomitant co-medication with benzodiazepines and/or gabapentinoids, and polypharmacy were evaluated during the baseline and follow-up periods. Adjusted logistic regression was used to evaluate the impact of baseline dosages on discontinuation and dose reduction. During follow-up, 60% of 2,669 SCS patients either discontinued opioid use or reduced opioid DD by at least 20% from baseline; another 15% reduced DD by 1-19%. Logistic regression showed patients with higher baseline dosages were less likely to discontinue opioids completely (odds ratio[OR] 95% confidence intervals[CI]: 0.31[0.18,0.54]) but more likely to reduce their daily dose (OR[CI]: 7.14[4.00,12.73], p<0.001). Mean PDC with opioids decreased from 0.58 (210 of 365 days) at baseline to 0.51 at year 3 (p<0.001). With SCS, co-medication with benzodiazepines decreased from 47.3% at baseline to 30.3% at year 3, co-medication with gabapentinoids reduced from 58.6% to 42.2%, and polypharmacy dropped from 15.6% to 9.6% (all p<0.001). Approximately three-quarters of patients who received SCS therapy either discontinued or reduced systemic opioid use over the study period. SCS could assist in reducing long-term reliance on opioids and other pain medications to treat chronic non-cancer pain.

Associations between Illicit ADHD Medication Use and Aspects of Mental Distress Among College Students

The illicit use of Attention-Deficit Hyperactivity Disorder (ADHD) medication has become a prevalent issue on college campuses. Illicit ADHD medications are used without a medical prescription. The concern is that these medications are psychostimulants that may alter brain chemistry and affect the quality of brain maturity in individuals who do not need them medically, which potentially can affect mental health. An alarmingly high percent of reported illicit ADHD medication users are college aged students between the age of 18 and 22 years. Little is known about the effect of illicit ADHD medication use on mental well-being among college students. Thus, the purpose of the study was to assess the impact of illicit ADHD medication use on different aspects of mental distress among college students. The study collected 702 responses from undergraduate students at several US colleges and included self-reported data on illicit Adderall use, age and symptoms of mental distress. The anonymous survey was created in Google Forms. Mental distress was evaluated through The Kessler Psychological Distress Scale (K10). The data were analyzed in SPSS, Version 28.0, using Pearson’s Correlation Coeffcient. Of the 72.5% of the participants who reported using ADHD medication without a prescription, 71.4% reported academic reasons as their motivation for use. There is a positive correlation between feelings of worthlessness and illicit ADHD medication use (p&lt;0.05). Age was negatively correlated with feelings nervous (p&lt;0.01) and restless or fidgety (p&lt;0.01). Additionally, a negative correlation was found between age and being able to do only half or less of what you would normally have been able to do (p&lt;0.01). On the other hand, illicit ADHD medication use was negatively correlated with feeling that everything was an effort (p&lt;0.05), as well feeling unable to work or carry out normal activities (p&lt;0.01). Our results suggest that students who use ADHD medication illicitly are more likely to experience symptoms of mental distress. Interestingly, our findings propose that the younger the age of use, the higher the risk of mental distress. We received no support or financial grants. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Medical Cannabis in Malaysia: Supply and Demand on Facebook

The internet has become a key hub for communication and information, including drug-related information. Evidence from other nations suggests that medical cannabis is also available online. Yet little is known about medical cannabis dealing on online services in Malaysia. This study examines the current supply and demand of medical cannabis on Malaysian Facebook Pages. Researchers searched for cannabis Facebook Pages in Malay and English between April and June 2022, using the keywords associated with cannabis and marijuana in popular search engines. The Facebook content, including the posts and users’ responses to supply and demand information for medical cannabis, were screened and analysed. Subsequently, the contents of the Facebook Pages were categorised into five themes: (1) demand for medical cannabis; (2) testimony; (3) supply information; (4) adverse health effects of medical cannabis; and (5) product types and routes of administration. The findings indicate that medical cannabis is available online and searchable via popular search engines, despite being illegal in Malaysia. A total of 46 Facebook Pages related to cannabis were identified in this study, where 13 pages sell medical cannabis directly, and 3 sell both medical and recreational cannabis. In addition to private messages via Facebook Messenger, most pages share contact details. The information on the sampled Facebook Pages reflected the growing demand and illegal sales of medical cannabis in Malaysia via online platforms since 2012. Thus, there is an urgent need for proper regulations and laws to control medical cannabis usage besides protecting patients against potentially harmful medical cannabis online.

Evaluation of post-operative pain following dental procedures under local anesthesia among pediatric patients at Al Rass, Saudi Arabia

The use of analgesic medication usage in children after receiving dental treatments on primary molars under local anesthesia is of interest. Hence, a study consisting of 182 children aged from 4 to 12 years old, who received at least one of the following procedures: dental restoration, extraction, placement of stainless steel crown (SSC) with or without pulpotomy was completed. Parents were contacted by phone within 48 hours to assess post-operative pain by using Wong-Baker FACES Pain Rating Scale (WBF). Individuals who were reachable via phone (146 out of 182, response rate 80.2%). 30.8% of them reported experiencing pain or discomfort (WBF more than or equal 2). Pediatric patients who had SSC on their primary molars had a considerably higher incidence of reporting pain than any other dental procedures are 44.8% at p &lt; 0.001. However, there was no significant difference in reported pain between placements of SSC alone or SSC with pulpotomy are 44.8% and 46.5%, respectively. Further, over-the-counter analgesics were administered in 19.9% of participants.

Evaluation of the Safety of Liberalized Systolic Blood Pressure Goals in the Postoperative Period After Intracranial Tumor Resection.

Postoperative intracranial hemorrhage (POH) is a serious neurosurgical complication occurring in approximately 1.4% of patients after intracranial tumor resection. The convention across the United States is to maintain an immediate postoperative systolic blood pressure (SBP) of < 140 mm Hg to minimize this risk; however, this SBP goal lacks support in the literature despite widespread adoption. This study aims to investigate the safety of SBP liberalization to 160 mm Hg in the immediate postoperative setting after intracranial tumor resection. A retrospective review was conducted on consecutive patients, aged 18 to 75 years, undergoing craniotomy for intracranial tumor resection from October 2020 until June 2023. Data were gathered from the electronic medical record per Institutional Review Board guidelines regarding demographics, operative details, perioperative vital signs, resource utilization, and complications. Pharmaceutical prices and insurance charges were approximated from costs provided by the institution's pharmacy. POH was defined as symptomatic hemorrhage within 48 hours requiring intervention. The study included 147 patients, with 104 in the liberalized cohort (SBP <160 mm Hg) and 43 in the standard cohort (SBP <140 mm Hg). The average age was 54.5 ± 14.9 years and 57.6 ± 10.6 years in the liberalized and standard groups, respectively (P = .23). Intensive care unit and hospital length of stay were not significantly different between groups. The liberalized group used $81.88 ± $280.19 (95% CI $53.01-$110.75) on as-needed antihypertensive medications vs $108.39 ± $215.91 (95% CI $75.96-$140.82) in the standard (P = .29), with significantly lower labetalol (P = .04). There was no POH in either cohort. Liberalization of SBP goals to <160 mm Hg appears safe in the immediate postoperative period after craniotomy for tumor resection without an increased POH risk. Liberalized SBP parameters may allow reduced antihypertensive medication usage, thereby avoiding excess hospital cost and medication side effects.

Progressive muscle relaxation alleviates anxiety and improves sleep quality among healthcare practitioners in a mobile cabin hospital: a pre-post comparative study in China.

To investigate the anxiety levels, sleep quality and potential risk factors of healthcare practitioners involved in the management of COVID-19 patients in a mobile cabin hospital, and further to assess the impact of progressive muscle relaxation (PMR) on their anxiety levels and sleep quality. We conducted a pre-post self-controlled trial. Healthcare practitioners meeting the inclusion criteria underwent daily 30-min PMR sessions for seven consecutive days. The Pittsburgh Sleep Quality Index (PSQI) and Hamilton Anxiety Scale (HAMA) were used to assess the anxiety and sleep quality of subjects pre- and post-intervention. Statistical analysis was performed using the Wilcoxon test, Mann-Whitney U test, Kruskal-Wallis H test, and Spearman rank correlation. A total of 94 participants completed the study. No statistically significant differences in HAMA or PSQI total scores were observed between groups categorized based on demographic variables such as age, sex, and years of education (p > 0.05). The PSQI total score and its components (excluding sleep medication usage) exhibited a positive correlation with the HAMA total score and its psychological anxiety component (p < 0.05), and a correlation was observed between somatic anxiety manifestations and several components of the PSQI. The PSQI total scores before and after intervention were 10.0 (8.0, 13.0) and 8.0 (6.0, 9.0) respectively (p < 0.001); the HAMA total scores were 8.0 (5.0, 13.0) and 6.0 (4.0, 9.5) respectively (p < 0.001). The detection rates of poor sleep and anxiety states, along with their severity, significantly decreased post-intervention (p < 0.001). Healthcare practitioners experience prominent anxiety and sleep issues in the mobile cabin hospital. PMR can be an effective intervention for improving the anxiety and sleep quality of healthcare professionals during support periods in the mobile cabin hospital. However, trials with larger samples are necessitated to further affirm these preliminary findings.

Clinical remission in severe asthma: lights and shadows on an ambitious goal.

The aim of this study was Describe the latest evidence related to the concept of clinical remission in patients with severe asthma, focusing on the lights and shadows of this concept. The idea of clinical remission in severe asthma patients brings about a significant shift in the way asthma is treated and managed. Although there has yet to be unanimous agreement among various scientific societies on the precise definition, this concept can be extremely useful in advancing the treatment of the disease. Asthma is a common respiratory condition that affects more than 300 million people globally. It has variable symptoms and severity levels, with about 10% of patients experiencing severe asthma. While there have been advancements in treatment, severe asthma poses significant challenges. Recent approaches have focused on achieving clinical remission, which goes beyond symptom control to address underlying inflammation and biological processes. Clinical remission criteria include the absence of symptoms, reduced medication usage, and normalized inflammatory markers. Various biologic therapies show promise, with some patients achieving remission. However, remission's definition varies globally, hindering standardization and a valid comparison. Standardizing remission criteria and refining predictive factors are crucial for effective asthma management. Overall, achieving clinical remission offers hope for improved long-term outcomes in severe asthma patients.

Subjective-Objective Sleep Discrepancy in a Predominately White and Educated Older Adult Population: Examining the Associations With Cognition and Insomnia.

This study examined associations between various cognitive domains and sleep discrepancy (self-reported vs objectively measured sleep), and evaluated interactive associations with insomnia status (non-insomnia vs insomnia). Older adults (N = 65, Mage = 68.72, SD = 5.06, 43 insomnia/22 non-insomnia) aged 60+ reported subjective sleep (7 days of sleep diaries), objective sleep assessment (one-night polysomnography, PSG, via Sleep Profiler during the 7-day period), and completed cognitive tasks (National Institutes of Health Toolbox-Cognition Battery) measuring attention and processing speed, working memory, inhibitory control, cognitive flexibility, and episodic memory. The sleep diary variable corresponding to the same one night of PSG was used to calculate the sleep discrepancy (diary minus PSG parameter) variables for total sleep time (TST), sleep onset latency, wake after sleep onset, and sleep efficiency. Regression analyses determined independent and interactive (with insomnia status) associations between cognition and sleep discrepancy, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. Working memory interacted with insomnia status in associations with sleep discrepancy related to TST and sleep efficiency. In those with insomnia, worse working memory was associated with shorter self-reported TST (p = .008) and lower sleep efficiency (p = .04) than PSG measured. In older adults with insomnia, worse working memory may be a contributing factor to sleep discrepancy. Future investigations of underlying neurophysiological factors and consideration of other objective sleep measures (actigraphy) are warranted. Prospective findings may help determine whether sleep discrepancy is a potential marker of future cognitive decline.

Reducing potentially inappropriate medication use and patient harm in a dedicated geriatric oncology clinic: a cross-sectional study

Abstract Introduction International guidance on conducting medication reviews in older adults with cancer was published in June 2022,[1] and current clinical practices have been outlined by pharmacists working in this field.[2] This process includes assessing for drug-drug interactions (DDIs), potentially inappropriate medications (PIMs), and assessing anticholinergic burden (ACB), all of which have been associated with poorer outcomes in older adults with cancer.[2] Since July 2022, the Geriatric Oncology Assessment and Liaison (GOAL) Clinic in our tertiary cancer centre has offered a comprehensive geriatric assessment (CGA) to patients ≥70 years, which includes a comprehensive geriatric pharmacological assessment (CGPA), performed by the primary author. Aim Identify pharmacist interventions that resulted in a reduction of medication use in older adults attending a geriatric oncology clinic. Methods Data were collected between July 2022 and September 2023 inclusive. Patients who attended the GOAL clinic consented and underwent a CGPA. The CGPA database was analysed to assess for recommendations that reduced medication usage via two metrics: (i) reduced doses of medications; (ii) deprescribing of medications. Descriptive statistics were used to analyse the data (Table 1). Results One hundred and seventy four patients (98%) consented to a CGPA. Interventions to reduce medication use occurred in 120 patients (69%). There were 199 total number of interventions, with some patients having more than one intervention. The nature of the interventions are described in Table 1. Conclusion A structured medication review in the form of a CGPA, alongside a multidisciplinary CGA is effective at identifying potential areas to reduce medication usage in older adults with cancer, through appropriate dose reductions and deprescribing strategies. This service is unique as the GOAL clinic is Ireland’s only dedicated geriatric oncology clinic. The utilisation of a clinical pharmacist in a geriatric oncology outpatient clinic can effectively identify opportunities to reduce inappropriate medication, with almost 70% of patients being identified as being prescribed potentially inappropriate medications. This study was limited to the outpatient setting only. Future research should consider the impact of pharmacist review of medications for older adults with cancer at transitions of care.